Play For Sport

Enrollment for Play For Sport Classes, Clinics, and Team Sports at NTA Sports
Facility Only!

Child 1 Name:
First, Last

Current Age:

Birthday


Male


Female

Child 2 Name:
First, Last

Current Age:

Birthday

Male

Female

Child 3 Name:
First, Last

Current Age:

Birthday

Male

Female

CLASS(ES) to
be Enrolled In:
(check all that
apply)

TEAMS TO
SIGN UP ON:

NEW
PLAYERS
ONLY

Current
Team
Members
please sign
up on team
page!

TEAM
Registration:

WINTER REGISTRATION IS NOW CLOSED FOR
INDOOR SOCCER AND BASKETBALL.
BASEBALL WILL RESUME IN THE SPRING

TEAM INFO:
Soccer for birthdays Aug 2005 thru July 31, 2008
Basketball for Grades entered in the fall

*Players on teams can play "up" in age but not "down"

Mother's Name:

Home Number:

Street Address:

City, State, Zip

Home Phone:

Work/Cell
Phone:

Primary Email
Address:

Secondary
Email:

Father's Name:

Home Number:

Street Address:

City, State, Zip

Home Phone:

Work/Cell
Phone:

Primary Email
Address:

Secondary
Email:

Choose Your
Child's
Shirt Sz:

Child 1:




Child 2:

Child 3:

Consent for Media
Usage:

Occasionally,Play For Staff, Inc. staff may photograph students with the intent of using the pictures in various publications and/or
on our web site (www.playforsport.com). Similarly, Play For Sport, Inc. may wish to promote our student's accomplishments by
sending press releases to appropriate newspapers or publications. In addition, representatives of the media may be interested
in stories relating to Play For Sport, Inc.and may wish to interview, photograph or videotape our students. Please complete this
form below. Non-response to this request will indicate that you grant permission as indicated below.

I HEREBY:			Permission for press releases to be distributed about my son/daughter, and for photographs of and/or interviews with my child to appear in other mediums for as long as my child(ren) is enrolled in Play For Sport, Inc.
	Grant


		Do Not Grant

Physical
Limitations:

Play For Sport, Inc. is a physically active program. Please list and describe below any injuries, allergies, or health conditions
which might limit your child’s participation.

Parental Consent:

I understand all fees are due in advance and that they are due regardless of absences. Any missed classes must be made up
within 30 days. AND I, the minor's parent and/or legal guardian, understand the nature of the above referenced activities and the
Minor's experience and capabilities and believe the minor to be qualified to participate in such activity. I HEREBY release and
hold harmless Play For Sport, Inc. and all its employees in the event of accidents and/or injuries that are caused or alleged to
have been caused by my child's participation.

		I accept and agree to the terms outlined above and certify that all information provided on this enrollment form is true and correct as of the date the enrollment form was submitted.